By Jerrold H. Levy
This ebook offers anaesthetists with a realistic method of the popularity, figuring out, and administration of life-threatening reactions to anaesthesia and different medications used in the course of surgical procedure and within the ICU.
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Additional info for Anaphylactic Reactions in Anesthesia and Intensive Care
Cutaneous manifestations were present in 85 percent of cases, cardiovascular in 85 percent, respiratory in 55 percent, and gastrointestinal in 25 percent. Thiopental is most often implicated, accounting for 268 cases, while methohexital has also been described in 22 cases. 220 Hirshman has demonstrated dose-related histamine release from human cutaneous mast cells by thiamylal and thiopental, but not methohexital or pentobarbital at barbiturate concentrations from 10 " 5 to 10~ 3 molar, drug levels that can be observed in clinical use.
The allergic manifestations of classic hemolytic transfusion reactions are produced by the interaction of antigen and antibody in the recipient by a Gel and Coombs Type II reaction while nonhemolytic transfusion reactions have different mechanisms. Hemolytic Transfusion Reactions Hemolytic reactions can be defined as the occurrence of increased red blood cell destruction after transfusion. 420 Following transfusion of ABO-incompatible blood, where IgG or IgM antibodies from the donor or recipient react with red blood cells, complement is fixed with lysis of the cells and liberation of complement anaphylatoxj n s 204,345 They may be sudden, appearing within 24 hours of transfusion, or delayed, developing 4 to 10 days later.
Mediators of Anaphylactic Reactions 35 Leukotrienes Leukotrienes are potent mediators, requiring only nanomolar concentrations to produce their effects. Composed of fatty acids with cystein and other sulfur linkages, they are synthesized de novo in response to cellular activation during anaphylaxis. Leukotrienes are generated by the oxidative metabolism of arachidonic acid through the 5-lipoxygenase pathway, a calcium-dependent pathway. 14·135 Leukotrienes B4, C4, and D4 have been studied both in vitro and in vivo and will be considered separately.
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